Part 5: Creative Accounting
I thought I would confess one of the strategies I employ in dealing with difficult-to-acquire capital items, something I call "creative accounting." As all of my experience has been in behavioral health operations, it was always been clear to me that providing the best equipment for the mentally ill has never been a priority in most hospitals.
In my last administrative position, the unit was old, the furniture was broken down (when the unit first opened the furniture had been acquired from the warehouse of discarded furniture with the belief that there was no point in providing decent furniture to patients who would not appreciate it or who would destroy it), and the floors in terrible disrepair. There were no supplies, no recreational equipment, and the whole environment was pretty sad. The nurses were still using thermometers with probes while every other unit had the ear thermometers. My nurses were still taking manual blood pressures while all the other units had electronic ones that operated automatically. All the other patient care units had a Pyxis machine for medication administration but we still had a rickety cart with wobbly wheels and drawers that wouldn't open or would fall out. The list could go on and on.
I requested capital funds year after year and was turned down. But because I spent just over the limit in every line item-other than salaries-each year I got a little more allocated for that line item in the budget. One of the line items was for repairs to materials and equipment, but this could not be used for replacement as that would be a capital expense with depreciation over several years while repairs were simply expensed out each year. So one year I "repaired" the floor. The whole floor. Three feet at a time. Continuously...until it was all new. If I had been questioned I simply would have said the floor was in such disrepair that I just kept repairing the parts that were dangerous and might trigger patient falls.
Another example I will share was cited in a book published by Sigma Theta Tau called "Ordinary People, Extraordinary Lives." It is a book about inspirational nurses whose personal stories were written by someone whose life the nurse impacted. I am honored to be one of the nurses included in this book and I will post to document sharing the story that was written about me by one of my graduates. That story, too, describes an example of creative accounting and how I used it for the benefit of the patients for whom I was responsible.
One of the most valuable things nurse managers and administrators can learn is how to find "workarounds" to solve problems that are caused by the often-rigid structures and policies within our organizations.
Both stories illustrate one of my mottos: "I would rather ask forgiveness than permission." I did what I needed to do for the patients and did so creatively. Does anyone have a similar story?
When I reflect further on "creative accounting" and tried to think of more examples, I first thought I would share my personal accounting activities in which I rely on the famous "float" so I use more of my money than the bank does, but then I realized the IRS might read the post and notice and I would have to finish my postings from a Federal prison...
Seriously, part of the strategy has to do with willingness to engage in risk-taking behavior. As you become more experienced, you begin to develop a sense, quite frankly, of what you can get away with in the system and which activities are too far below the radar to get anyone's attention.